Here's A Major Change That Hospital Ranking Systems Need To Make

If you're lucky enough to be able to choose your hospital and have time to research your choices, you'd naturally take mortality rate into account. There's a problem with that, and one change in how mortality rates are calculated could help solve it.

Hospital rankings according to mortality rate are needed to identify those that need investigation, help potential patients determine which hospital is best for them, and allow people to get an overview of how the health system is working. A study published today found a potential problem with these rankings while analysing them with regard to mortality rates due to pneumonia. Many rankings didn't take into account the fact that patients have do-not-resuscitate (DNR) orders.

DNRs are written by doctors, at the request of patients who do not want to be resuscitated should their heart stop beating. It's unpleasant to think about, but many patients face a long, painful life of constant medical intervention if they are resuscitated. While some want every intervention possible, others simply aren't interested in prolonging their life under some circumstances. That's their business, and hospitals right to respect it. But according to the study, respecting a patient's wishes can cost a hospital:

After accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality . . . . Only 14 of 27 hospitals (51.9%) characterised as low-performing outliers without accounting for DNR status remained outliers after DNR adjustment.

What's key is that hospitals with high DNR rates had lower mortality than ones with lower DNR rates -- which means that the high quality care of allowing patients to die without intervention if they chose to do so masks the equally high quality care of keeping them alive with interventions if they chose to do that.